Skip to main content
SpringerLink
Log in

Coxa Saltans: Iliopsoas Snapping and Tendonitis

Hip Arthroscopy and Hip Joint Preservation Surgery

  • 204 Accesses

Abstract

Painless snapping of the iliopsoas tendon occurs in 10 % of the general population during sports activities and to a lesser extent, activities of daily living. In asymptomatic individuals, no treatment is required. Painful snapping iliopsoas tendons and the associated tendinitis are common in young, physically active individuals that participate in sports that demand repeated abduction of the leg above waist level. When the snapping is symptomatic, distinguishing between the internal (snapping iliopsoas tendon) and intra-articular causes (e.g., labral tears) often is difficult because these two conditions have many of the same clinical findings. Thus, the goal of this chapter is to define the unique characteristics of a snapping iliopsoas tendon that distinguish it from the intra-articular causes of snapping through a review of the (1) pertinent anatomy, (2) clinical presentation, (3) role of the various imaging modalities, and (4) outcomes and complications of open and arthroscopic treatment of the painful, snapping iliopsoas tendon.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. Allen WC, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg. 1995;3:303–8.

    PubMed  Google Scholar 

  2. Brignall CG, Stainby GD. The snapping hip: treatment by Z-plasty. J Bone Joint Surg Br. 1991;73:253–4.

    CAS  PubMed  Google Scholar 

  3. Dobbs MB, Gordon E, Luhmann SJ, et al. Surgical correction of the snapping iliopsoas tendon in adolescents. J Bone Joint Surg Am. 2002;84:420–4.

    PubMed  Google Scholar 

  4. Flanum ME, Keene JS, Blankenbaker DG, DeSmet AA. Arthroscopic treatment of the painful “internal” snapping hip: results of a new endoscopic technique and imaging protocol. Am J Sports Med. 2007;35:770–9.

    Article  PubMed  Google Scholar 

  5. Hoskins JS, Burd TA, Allen WC. Surgical correction of internal coxa saltans: a 20-year consecutive study. Am J Sports Med. 2004;32:1–4.

    Article  Google Scholar 

  6. Ilizaliturri Jr V, Villalobos Jr F, Chaidez P, et al. Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy. 2005;21(11):1375–80.

    Article  PubMed  Google Scholar 

  7. Lyons JC, Peterson FAL. The snapping iliopsoas tendon. Mayo Clin Proc. 1984;59:327–9.

    Article  CAS  PubMed  Google Scholar 

  8. Rotini R, Spinozzi C, Ferrari A. Snapping hip: a rare form of internal etiology. Ital J Orthop Traumatol. 1991;17:283–8.

    CAS  PubMed  Google Scholar 

  9. Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med. 1990;18:470–4.

    Article  CAS  PubMed  Google Scholar 

  10. Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR. 2008;190:576–81. doi:10.2214/AJR.07.2375.

    Article  PubMed  Google Scholar 

  11. Domb BG, Shindle MK, McArthur B, Boos JE, Magennis EM, Kelly BT. Iliopsoas impingement: a newly identified cause of labral pathology in the hip. HSSJ. 2011;7:145–50. doi:10.1007/s11420-011-9198-z.

    Article  Google Scholar 

  12. Tatu L, Parratte B, Vuillier M, et al. Descriptive anatomy of the femoral portion of the iliopsoas muscle: anatomical basis of anterior snapping of the hip. Surg Radiol Anat. 2001;23:371–4.

    Article  CAS  PubMed  Google Scholar 

  13. Alpert JM, Kozanek M, Li G, Kelly BT, Asnis PD. Cross-sectional analysis of the iliopsoas tendon and its relationship to the acetabular labrum: an anatomic study. Am J Sports Med. 2009;37:1594–8.

    Article  PubMed  Google Scholar 

  14. Blomberg JR, Zellner BS, Keene JS. Cross-sectional analysis of iliopsoas muscle-tendon units at the sites of arthroscopic tenotomies. Am J Sports Med. 2011;39 Suppl 1:58S–63S. doi:10.1177/0363546511412162.

    Article  PubMed  Google Scholar 

  15. Byrd JWT. Snapping hip. Oper Tech Sports Med. 2005;13(1):46–54.

    Article  Google Scholar 

  16. Byrd JWT. Evaluation and management of the snapping iliopsoas tendon. Tech Orthop. 2005;20(1):45–51.

    Article  Google Scholar 

  17. Anderson SA, Keene JS. Results of arthroscopic iliopsoas tendon release in competitive and recreational athletes. Am J Sports Med. 2008;36:2363–71.

    Article  PubMed  Google Scholar 

  18. Arnold DR, Keene JS, Blankenbaker DG, DeSmet AA. Hip pain referral patterns in patients with labral tears: analysis based on intra-articular anesthetic injections, hip arthroscopy and a new pain “circle” diagram. Phys Sportsmed. 2011;39(1):1–7.

    Article  Google Scholar 

  19. Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology. 1996;200:225–30.

    Article  CAS  PubMed  Google Scholar 

  20. Hodler J, Yu JS, Goodwin D, Haghighi P, Trudell D, Resnick D. MR Arthrography of the hip: improved imaging of the acetabular labrum with histologic correlation in cadavers. AJR. 1995;165:887–91.

    Article  CAS  PubMed  Google Scholar 

  21. Petersilge CA, Haque MA, Petersilge WJ, et al. Acetabular labral tears: evaluation with MR arthrography. Radiology. 1996;200:231–5.

    Article  CAS  PubMed  Google Scholar 

  22. Byrd JWT. Labral lesions: an elusive source of hip pain. Arthroscopy. 1996;12:603–12.

    Article  CAS  PubMed  Google Scholar 

  23. Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;32:1668–74.

    Article  PubMed  Google Scholar 

  24. Petersilge CA. Chronic adult hip pain: MR arthrography of the hip. Radiographics. 2000;20:S43–52.

    Article  PubMed  Google Scholar 

  25. Petersilge CA. MR arthrography for evaluation of the acetabular labrum. Skeletal Radiol. 2001;30:423–30.

    Article  CAS  PubMed  Google Scholar 

  26. Cardinal E, Buckwalter KA, Capello WN, et al. US of the snapping iliopsoas tendon. Radiology. 1996;198:521–2.

    Article  CAS  PubMed  Google Scholar 

  27. Schaberg JE, Harper MC, Allen WC. The snapping hip syndrome. Am J Sports Med. 1984;12:361–5.

    Article  CAS  PubMed  Google Scholar 

  28. Vaccaro JP, Sauser DD, Beals RK. Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome. Radiology. 1995;197:853–6.

    Article  CAS  PubMed  Google Scholar 

  29. Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings. Am J Roentgenol. 2001;176:67–73.

    Article  CAS  Google Scholar 

  30. Blankenbaker DG, DeSmet AA, Keene JS. Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip. Skel Radiol. 2006;35(8):565–71. doi:10.1007/s00256-006-0084-6.

    Article  Google Scholar 

  31. Wahl CJ, Warren RF, Adler RS, Hannafin JA, Hansen B. Internal coxa saltans (snapping hip) as a result of overtraining. Am J Sports Med. 2004;32(5):1302–9.

    Article  PubMed  Google Scholar 

  32. Adler RS, Buly R, Ambrose R, Sculco T. Diagnostic and therapeutic use of sonography-guided iliopsoas peritendinous injections. AJR Am J Roentgenol. 2005;185:940–3.

    Article  PubMed  Google Scholar 

  33. Gruen GS, Scioscia TN, Lowenstein JE. The surgical treatment of internal snapping hip. Am J Sports Med. 2002;30:607–13.

    PubMed  Google Scholar 

  34. Taylor GR, Clarke NMP. Surgical release of the “snapping iliopsoas tendon”. J Bone Joint Surg Br. 1995;77:881–3.

    CAS  PubMed  Google Scholar 

  35. Harper MC, Schaberg JE, Allen WC. Primary iliopsoas bursography in the diagnosis of disorders of the hip. Clin Orthop. 1987;221:238–41.

    PubMed  Google Scholar 

  36. Ilizaliturri Jr VM, Chaidez C, Villegas P, et al. Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy. 2009;25(2):159–63.

    Article  PubMed  Google Scholar 

  37. Ludwig BJ, Keene JS. Long-term outcomes of arthroscopic iliopsoas tenotomies: results in 60 consecutive cases. www.ishameetings.net/meetings/2013/paper/presentations

  38. Wettstein M, Jung J, Dienst M. Arthroscopic psoas tenotomy. Arthroscopy. 2006;22:907.e1–4.

    Article  Google Scholar 

  39. Byrd JWT, Polkowski G, Jones KS. Endoscopic management of the snapping iliopsoas tendon. Arthroscopy Association of North American 2009 Annual meeting, San Diego, CA.

    Google Scholar 

  40. Shu B, Safran MR. Bifid iliopsoas tendon causing refractory internal snapping hip. Clin Orthop. 2011;469(1):289–93.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Contreras MEK, Dani WS, Endges WK, Araujo LCT, Berral FJ. Arthroscopic treatment of the snapping iliopsoas tendon through the central compartment of the hip. J Bone Joint Surg Br. 2010;92(6):777–80. doi:10.1302/o301-620X.9286.22797.

    Article  CAS  PubMed  Google Scholar 

  42. Arabia WHM, Gómez J, Serna JFL, Bohorquez BA, Barrera JMN, et al. Regrowth of the psoas tendon after arthroscopic tenotomy: a magnetic resonance imaging study. Arthroscopy. 2013;29(8):1308–13. http//dx.doi.org/10.10161/j.arthro.2013.05.002.

  43. Nelson IR, Keene JS. Results of labral-level arthroscopic iliopsoas tenotomies for treatment of labral impingement. Arthroscopy. 2014;30(6):688–694.

    Google Scholar 

  44. Bayer JL, Keene JS. Comparison of the amount of iliopsoas tendon lengthening that occurs after arthroscopic labral-level and lesser trochanteric tenotomies. www.sportsmed.org/apps/aossm_2013/scientific_posters.html.

  45. Fabricant PD, Bedi A, De La Torre K, Kelly BT. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral anteversion. Arthroscopy. 2012 (Online).

    Google Scholar 

  46. Hain KS, Blankenbaker DG, De Smet AA, Keene JS, Munoz del Rio A. MR appearance and clinical significance of changes in the hip muscles and iliopsoas tendon after arthroscopic iliopsoas tenotomy in symptomatic patients. HSSJ (Hospital Special Surg J). 2013;9(3):236–241.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Sports Medicine, University of Wisconsin, 1685 Highland Ave., Madison, WI, 53705, USA

    Dr. James S. Keene M.D. (Professor of Orthopedic Surgery)

Authors
  1. Dr. James S. Keene M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James S. Keene M.D. .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Shane Nho

  2. Dept. Orthopaedics, Hip Service, Schulthess Clinic, Zurich, Switzerland

    Michael Leunig

  3. Caspary Building, Ground Floor, Center for Hip Pain and Preservation, New York, New York, USA

    Bryan Kelly

  4. Department of Orthopaedics, University of Michigan Domino's Farms Lobby A, Ann Arbor, Michigan, USA

    Asheesh Bedi

  5. Twin Cities Orthopedics - Edina, Edina, Minnesota, USA

    Christopher Larson

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this entry

Cite this entry

Keene, J.S. (2014). Coxa Saltans: Iliopsoas Snapping and Tendonitis. In: Nho, S., Leunig, M., Kelly, B., Bedi, A., Larson, C. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_64-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_64-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Online ISBN: 978-1-4614-7321-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Coxa Saltans: Iliopsoas Snapping and Tendonitis
    Published:
    01 December 2021

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_64-2

  2. Original

    Coxa Saltans: Iliopsoas Snapping and Tendonitis
    Published:
    15 June 2014

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_64-1

Search

Navigation